=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760558647
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARL J POCHE MD, APMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2454 LOUISIANA AVE
-----------------------------------------------------
City | LUTCHER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-860-3493
-----------------------------------------------------
Fax | 225-869-9333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 369
-----------------------------------------------------
City | LUTCHER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70071-0369
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-869-3493
-----------------------------------------------------
Fax | 225-869-9333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CARL J POCHE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 225-869-3493
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | LA7775
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------